Message from the CEO
Good news alert! I feel the need to open with that announcement given the barrage of challenges we face in health care and the unending pandemic twists and turns we continue to manage. Good news in health care can easily be dwarfed by stories of heartache and sorrow, yet if you simply look around, there are hopeful signs all around us.

Last week, a positive and optimistic story emerged regarding our state’s health reform initiative. The headline is that in 2018 and 2019, Vermont made measurable and meaningful progress toward a value-based health care system where the primary focus is on prevention, care management and coordination around each patient.

The report recognizing Vermont’s progress was from the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the implementation of our state’s All Payer Model (APM) reform plan.

According to CMS, the APM achieved statistically significant Medicare gross spending
reductions at both the ACO (that’s OneCare Vermont) and state levels. It also showed Medicare net spending reductions at the state level. Additionally, there were statistically significant declines in acute care stays (at both the ACO and state levels) and in 30-day readmissions.

In plain English, there were savings from our work and declines in unnecessary or avoidable hospital stays, which we know lead to better health outcomes. While the model’s mechanics are incredibly complex, the concept is quite simple. In the most basic terms, we are bringing together providers to care for the whole person, giving doctors data and support to promote best practices, create greater collaboration with the patient and focus more on wellness and disease management than tests and procedures.

These results are profound. Not because we’ve realized the vision of value-based care or
population health, but because it shows that as far back as 2018 (which feels like a lifetime ago at this point), we were on the right track. There is no question COVID-19 has disrupted our work, but there’s also no question we are in a better place as a result of the APM and OneCare as we continue to weather the pandemic.

It’s easy to find criticism of health care reform work in Vermont—some fair and some not. Chief among the complaints is the pace at which change is realized. Well, have you or someone you know ever tried to lose weight, control blood pressure or manage chronic depression? If you have, you know that this work takes time—a lot of time—and, often it’s a life-long, decades-long journey.

It stands to reason that this health reform journey and the true change we seek will not happen during the five-year APM waiver we’re about to conclude or during an extension or even a next generation waiver. It will happen over time as we work with providers, state leaders and Vermonters themselves.

We are as committed to this work now as we ever were. CMS has given us compelling proof points that we are on the right track. With continued team work and commitment, we will both improve the lives of Vermonters and bend health care’s cost curve.

Here’s to some good news. Let’s be on the lookout for more!
VAHHS Annual Meeting: Forward Together
A bit about our keynote speaker
We're excited to welcome Aron Ralston as our keynote speaker at the 2021 VAHHS Annual Meeting: Forward Together. Aron Ralston's extraordinary story of survival after an 800-pound boulder trapped him in a remote Utah canyon captured global headlines in 2003. In his New York Times best seller, Between a Rock and a Hard Place, the Oscar-nominated film, 127 Hours, and on stage, Ralston takes audiences vicariously through those six days without water, means of communication, or hope of escape, to the ecstatic moments when he freed himself by severing his own arm.

Following a miraculous rescue spearheaded by his mom and with the aid of prosthetics he helped design, Aron returned to his outdoor passions, completing elite mountaineering projects which remain unrepeated even to this day. He has interviewed with Tom Brokaw, David Letterman, and Jay Leno, and received standing ovations and industry-leading testimonials from more than five hundred groups around the world. Attendees credit Ralston's story with encouraging them through disease, disability, and loss, even saving their lives from suicide and depression. 

Aron's incredible triumph in the face of insurmountable odds inspires audiences to harness the power of their deepest motivations, relationships, and mindset to transform personal and professional "boulders" into their blessings.
A shout out to just one of our amazing sponsors, Primmer Piper Eggleston and Cramer PC. Thanks!!!
In the News
Report finds Vt. health care reform efforts showing promise

A new independent report shows “promising” results in Vermont’s health care reform efforts. It says that the all-payer model, which aims to cut health care costs and keep people out of the emergency room, is paying off.

“I think this is a huge deal for all-payer, in that it’s showing that it does have promise,” said Vicki Loner, the CEO of OneCare Vermont, the Accountable Care Organization made up of hospitals and providers participating in the all-payer model.

It shows big Medicare cost savings for the first two years -- about $600 annually per patient -- and a decline in the number of patients seeking acute hospital care.

“Those things are starting to say, focusing on the patient’s health -- the total health of the patient -- is the way to go,” said Vt. Agency of Human Services Secretary Mike Smith.

Hospitals in Even the Most-Vaccinated States Are Starting to Feel the Squeeze
National Review

Last week I observed that between July 6 and August 31, the number of active cases of COVID-19 infection in the state of Vermont increased 23-fold — from 114 to 2,668.

But I noted the state is not really in a public-health crisis — hospitalizations and daily new deaths remain low in Vermont, in large part because the state is heavily vaccinated, and in part because Vermont is one of the least-populated states in the country.

There’s a notable update to that conclusion, because in the past few days, Vermont — vaccination-filled Vermont, where more than 86 percent of those eligible for vaccination have at least one shot! — is experiencing concerns about hospital capacity.

The state’s largest hospital is straining to care for “a very high number of patients” amid Vermont’s rising coronavirus cases, according to information the hospital provided on Friday afternoon.
Green Mountain Care Board Joins State Probe of Wait Times for Medical Care
Seven Days

Vermont's chief health care regulator, the Green Mountain Care Board, announced Friday that it will join a state investigation of long wait times for medical appointments.

The long-simmering crisis was the subject of a Seven Days cover story this week that detailed how patients are waiting months for specialty care at the state's largest hospital, the University of Vermont Medical Center in Burlington.

The care board, which is one of the most powerful health care regulators in the country, has known about access challenges at both UVM and other Vermont hospitals for years but has done little to compel improvement.
Upper Valley hospital officials say worker shortage is limiting capacity for care
Valley News

Dr. Joanne Conroy has experienced firsthand the impact of staffing shortages on patients at Dartmouth-Hitchcock Medical Center.

One of the health system’s responses to a lack of workers has been to halt blood draws at its Heater Road medical building in Lebanon on weekdays. Instead, patients are directed to the main DHMC campus for that service during the week. It was there, on the third floor, that the Dartmouth-Hitchcock Health CEO recently found herself, needing to have her own blood drawn.

There were so many other patients waiting that after 30 minutes, she left with plans to return later in the day.

“Kind of a madhouse,” she described the scene in a phone interview last week.

A behind-the-scenes look at Covid testing

As COVID cases continue to surge across the region, rural hospitals like the Gifford Medical Center are playing an even bigger role.

“Being able to test, test quickly, and test lot of people,” said Matthew Clayton, who manages the lab at the Gifford Medical Center. He says they are currently processing about 30 tests a day. The sample is labeled, transferred to a testing container under a negative pressure hood, then analyzed for traces of the virus using specific machines. Results take about an hour.

“As these exposures occur and we are able to do the testing right on that spot and be able to clear people, that is going to help us move out of this pandemic,” Clayton said.

Though, at this point, the experts say there is not an end date in sight. “Far from over. This is going to be a wave and cycle that we are going to have to manage,” said Monica Boyd, the medical center’s vice president of quality and compliance.
Hospitals in the News
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